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Abstract:

An instrument for removing by suction saliva, water or other materials
generated or used in connection with procedures carried out in the region
of the mouth. The instrument includes a substantially tubular, elastic
frame arranged for suction, a finger part for attaching the instrument to
a finger, and a tip part located, in an axial direction, farther out than
the finger part and including a suction inlet. The tip part is arranged
to be rotatable around the axial direction of the frame.

Claims:

1. An instrument for sucking saliva or other secretions or objects out of
a patient's mouth, nose, throat or lower respiratory tract, and for
removing by suction water or other materials generated or used in
connection with procedures carried out in the region of the mouth, nose
or respiratory tract, the instrument comprising: a substantially tubular,
elastic frame provided with a channel arranged therein for a suction
flow; a finger part for attaching the instrument to a finger; and a tip
part located, in an axial direction, farther out than the finger part and
including a suction inlet communicating with the channel, wherein: the
tip part is arranged to be rotated around the axial direction of the
frame.

2. An instrument as claimed in claim 1, wherein the tip part is arranged
to be moved into several different positions located at a predetermined
angle from one another.

3. An instrument as claimed in claim 2, wherein the angle is about 90
degrees.

4. An instrument as claimed in claim 1, wherein the frame and the finger
part arranged therein are curved in shape.

5. An instrument as claimed in claim 1, wherein the axial direction of a
tip of the finger part is substantially parallel with the axial direction
of the tip part.

6. An instrument as claimed in claim 1, wherein the finger part is
provided with a cut to divide the finger part into a front part and a
rear part.

7. An instrument as claimed in claim 1, wherein the tip part comprises
one or more projections arranged adjacent to the suction inlet for
preventing the tip part from adhering to a target surface in a use
situation because of the suction flow.

8. An instrument as claimed in claim 1, wherein an angle α between
a substantially planar surface defined by the suction inlet of the tip
part and the axial direction is greater than 25 degrees.

9. An instrument as claimed in claim 1, wherein a distal end of the tip
part is rounded.

10. An instrument as claimed in claim 1, wherein the tip part is
adjustable in the axial direction with respect to the finger part.

11. An instrument as claimed in claim 1, wherein the finger part is
generally sheath-like, comprising one or more openings for leaving a
distal interphalangeal joint and/or a proximal interphalangeal joint of
the finger free.

12. A method of producing an instrument arranged for sucking saliva or
other secretions or objects out of a patient's mouth, nose, throat or
lower respiratory tract, and for removing by suction water or other
materials generated or used in connection with procedures carried out in
the region of the mouth, nose or respiratory tract, the method
comprising: arranging in a substantially tubular, elastic frame provided
with a channel arranged therein for a suction flow: a finger part for
attaching the instrument to a finger; and a tip part located, in an axial
direction, farther out than the finger part and including a suction inlet
communicating with the channel, and arranging the tip part to be
rotatable around the axial direction of the frame.

Description:

FIELD OF THE INVENTION

[0001] The invention relates to an instrument in connection with oral and
dental care, and particularly to an instrument which enables accurate and
efficient working while at the same time minimizing stresses imposed on a
worker.

BACKGROUND OF THE INVENTION

[0002] Oral and particularly dental care involves performance of various
procedures, such as removal of biofilm or plaque, removal of
discolorations and dental calculus, dental filling procedures and the
like, that can be carried out by a dentist assisted by a dental assistant
or by a dentist, a dental assistant or an oral hygienist individually.

[0003] According to hftp://www.tohtori.fi/?page=5446580&id=56884 07
(visited on 23 Jun. 2011) an oral hygienist's job description entails,
among other things, providing oral health examination, cariological
screening, regional treatment programs and implementation of treatment as
well as opinions within his or her area of responsibility. An oral
hygienist notices mucosal changes in a patient, examines the patient's
occlusion and, when necessary, refers him or her to a dentist. In
addition, the oral hygienist is an expert in the factors associated with
the origin, progress and treatment of periodontal diseases.

[0004] When oral care is carried out as teamwork, i.e. when a dentist
performs the actual treatment procedures, an assisting person performs
the rest of the related procedures. Such procedures include e.g. removal
of saliva and washing-off liquids, polish and filling residues as well as
blood and medical substances out of the patient's mouth. This enables the
dentist to freely concentrate on his or her own work.

[0005] Often, however, oral and dental care procedures are carried out by
one person working alone, in which case the person's musculoskeletal
system is subjected to strain in different work postures. When working
alone, it is impossible e.g. for an oral hygienist to always maintain the
best possible ergonomic work posture but sometimes he or she has to work
in non-ergonomic postures. In oral health care, the confined space of the
working area inside the mouth and the design of instruments often compel
a hand into positions wherein the generation of force is harmful to the
joints, muscles and tendons. The work of an oral hygienist thus comprises
several risk factors that may cause musculoskeletal diseases, in the area
of the upper limbs and the back as well as in the neck and shoulder area
in particular.

[0006] The clinical work of an oral hygienist thus involves a lot of
manual work and requires special accuracy. In accordance with prior art,
the work includes applying a lot of compressive force by the fingers when
operating with different instruments. The task of directing instruments
and the accurate working require stiffening of the joints of an upper
limb as well as maintenance of both the gaze and the posture of the head
by means of the muscles in the neck and shoulder area.

[0007] According to a publication entitled "Suuhygienisteilla ilmenevat
tuki- ja liikuntaelimiston terveysongelmat seka niiden ennaltaehkaisy" by
Laura Heikkila and Hanne Ilvonen, the most common diseases caused by
stress on the upper limbs are tenosynovitis, epicondylitis of the humerus
and carpal tunnel syndrome. Work-related risk factors increasing a
person's chances of developing tenosynovitis are the high recurrence of
work movements, use of strong compressive manual force, and bent
positions of the wrist. In addition to those mentioned above, the risk
factors for epicondylitis of the humerus include power-demanding
flexion-extension movements of the wrist and the fingers as well as
rotational movements of the forearm. The risk factors for carpal tunnel
syndrome are the same as those for tenosynovitis and epicondylitis of the
humerus. A tweezer grip of the hand and use of vibrating instruments are
also risk factors for the aforementioned stress-related diseases. In
addition, the oral hygienist performs the dental care procedures in a
sitting position in which the recurrent uplifted positions of the upper
limbs, reaching out and extreme rotational movements impose stress on the
muscles of the shoulders and upper arms and in which controlling the
dimensions and use of force is difficult.

[0008] The aforementioned procedures for removing different materials from
the patient's mouth are almost invariably carried out by means of a
vacuum-operated suction system. Generally, a dental care unit is provided
with high volume evacuation operating at a greater underpressure and
suction which operates at a lower underpressure and which often refers to
a device for saliva suction to be hung from the patient's lower jaw; such
devices may come in different shapes and are designed for removing saliva
collected in the mouth e.g. during a filling procedure and often for
simultaneously keeping the tongue out of the working area.

[0009] When another person is in charge of the high volume evacuation, the
work runs smoothly, both of the dental workers knowing their own tasks.
However, it is quite often the case that only one dental worker is
present, which naturally means that all procedures then fall into his or
her responsibility.

[0010] While working alone, the liquid removal from the patient's mouth is
particularly problematic and laborious. Procedures wherein a lot of water
collects in the mouth require the use of high volume evacuation and a
high volume evacuation tip associated therewith. The high volume
evacuation tip is designed for the conventional teamwork between a
dentist and a dental assistant. The dental assistant is responsible for
removing liquid by the high volume evacuation tip, enabling the dentist
to concentrate on the clinical procedure. As the oral hygienist's job
description expands, the number of clinical procedures demanding accuracy
has increased also in the work of a dental assistant and oral hygienist:
a need exists for a more accurate removal of liquid and other materials
that is less tissue-damaging than the current suction tip solutions, as
well as for more ergonomic working.

[0011] WO 2005/107832 A1 describes a hand mounted surgical aspiration
device. According to the publication, the suction tip to be attached to a
finger provides a surgeon with a better view of the operative field when
no assistant interferes with the surgeon's field of vision. However, in
order to direct the suction at the operative field according to a first
embodiment of the publication, the suction has to be squeezed between the
fingers. In the sheath-like solution of a second embodiment of the
publication, a suction tube is shorter than a finger, in which case the
finger interferes with the suction and the use of the suction is
inaccurate. Further, the sheath completely covers the distal
interphalangeal joint of the finger while the distal interphalangeal
joint resides inside the sheath. In such a case, when the finger is bent,
the sheath imposes pressure on the distal interphalangeal joint which is
subjected to pressure and resistance by the sheath, and the joint is
subjected to stress.

[0012] SE 468237 describes a device for removing saliva by means of
suction. A problem with the publication is, however, that in practice a
finger clamp attached to the metacarpophalangeal joint of a finger leaves
the end of the suction tube hanging, thus making the suction impossible
to be directed accurately to the target area.

BRIEF DESCRIPTION OF THE INVENTION

[0013] It is thus an object of the invention to provide a method and an
apparatus implementing the method so as to enable the aforementioned
problems to be solved. The object of the invention is achieved by a
method and a system which are characterized by what is disclosed in the
independent claims. Preferred embodiments of the invention are disclosed
in the dependent claims.

[0014] The idea underlying the invention is that a substantially tubular
and elastic frame arranged for suction is provided with a finger part for
attaching the instrument to the finger and with a tip part which, in an
axial direction, is located farther out than the finger part and which
includes a suction inlet, and that the tip part is arranged to be rotated
around the axial direction of the frame.

[0015] An advantage of the method and system according to the invention is
an instrument which is accurately and efficiently directable while at the
same time it is possible to minimize stresses imposed on a worker caused
by the use of the instrument.

BRIEF DESCRIPTION OF THE FIGURES

[0016] The invention is now described in closer detail in connection with
the preferred embodiments and with reference to the accompanying
drawings, in which:

[0017] FIG. 1 shows an instrument according to an embodiment of the
invention;

[0018] FIG. 2 shows a side sectional elevation of an instrument according
to an embodiment of the invention;

[0019] FIG. 3 shows an instrument according to an embodiment of the
invention in a use situation;

[0020] FIGS. 4a, 4b, and 4c show a tip part and a finger part according to
an embodiment of the invention;

[0021] FIG. 5 shows a finger part according to an embodiment of the
invention;

[0022] FIG. 6 shows anatomy of a hand;

[0023] FIGS. 7a, 7b, 7c, and 7d show a rotation mechanism for a tip part
of an instrument according to an embodiment of the invention;

[0024] FIGS. 8a, 8b, and 8c show a rotation mechanism for a tip part of an
instrument according to an embodiment of the invention;

[0025] FIG. 9 shows an instrument according to an embodiment of the
invention with a tip part detached;

[0026] FIG. 10 shows a finger part of an instrument according to an
embodiment of the invention as seen from behind; and

[0027] FIG. 11 is a front view showing a finger part of an instrument
according to an embodiment of the invention.

DETAILED DESCRIPTION OF THE INVENTION

[0028] FIG. 1 is an axonometric view of an instrument according to the
invention and its preferred embodiments. The instrument generally
comprises a tubular elongated frame 2 provided with a channel arranged
therein for a suction flow. By means of a simple friction joint or
another appropriate joint, the frame or tube or suction tube 2 is
attachable at its end designated by reference number 7 to an end of an
existing suction tube or a suction machine or an extension tube. A
relatively close-fit joint without any other connecting devices suffices
in ordinary conditions to keep the instrument 1 in place in working
conditions. If desired, threads or other kind of securing applications
found in abundance in different fields of technology may also be used.

[0029] In FIG. 1, as in FIG. 2, the instrument is described as a straight
tubular part but, as can be seen in FIG. 3, in operating conditions the
instrument is more or less curved so as to adapt to the shapes of a hand.

[0030] In terms of its diameter and edge thickness as well as length, the
tubular frame 2 may be dimensioned in a manner appropriate for practical
work and existing parts. The frame 2 is particularly made of an elastic
and flexible material, plastic in particular, which may be partly or
completely transparent or non-transparent.

[0031] Reference number 3 designates a finger part, such as an annular
part, an opening formed thereby being substantially parallel with a
longitudinal axis of the frame 2. As can be seen in FIG. 1, said part 3
resembles a ring having quite a large width. FIG. 3, in turn, shows the
purpose of said part, i.e. that in the case of a sheath-like finger part
the finger is to be pushed into a sheath and in the case of an annular
finger part the finger is to be pushed through the annulus, thus enabling
the finger to be used for directing the end of the instrument 1 at a
desired point to aspirate saliva or other materials to be removed
collected therein.

[0032] The part 3 is herein described as a ring having quite a large width
but, as will be understood, a certain width enables the instrument to be
made easier and more accurate to direct; however, the width per se is not
critical, and a part which is almost threadlike is also sufficient. The
ring part may also be formed spirally.

[0033] The part 3, when proceeding in another direction, again, may also
be sheath-like, in which case the finger is pushed into the sheath in
order to attach the instrument. The finger part 3 may also consist of two
or three annular parts.

[0034] The annular part 3 may also be a cut ring. The cutting may be
implemented in many different ways, e.g. such that an incision in the
ring part is made parallel with the circumference in a longitudinal
direction or obliquely. This enables the elasticity properties to be
utilized since an annular structure of a given elasticity tends to bend
and maintain the shape of the ring. This enables the size of the ring to
be adjusted to automatically fit fingers of all sizes. A division may be
made in the ring part also in a direction perpendicular to the direction
of the circumference.

[0035] Thus, by selecting the elasticity of the material appropriately, a
finger having an ordinary thickness may be arranged in the ring. In the
case of a thicker finger, the ring opens up slightly without compressing
the finger too much, however. Alternatively, the instrument may be
manufactured in different size classes so as to fit any finger thickness.
The annular finger part may be arranged on a tip and/or middle member of
a finger. A clamp to be fastened around the finger in any manner may be
selected for the attachment. One alternative may be e.g. a tape-like
fastening device comprising adhesive fastening, e.g. as a small piece of
Velcro tape. Various other manners of fastening from different fields of
technology may also be used.

[0036] An end of the instrument facing the working point is provided with
a separate tip part 4 whose outer end may be provided with one or more
gaps 5 for preventing the tip of the instrument from entering a closed
state preventing air flow. The gaps always allow for a flow of certain
degree even if the tip were in contact with tissue, oral mucosa or a
tooth, for instance. The tip part may also be called a tip, suction tip
or a high volume evacuation tip. The gaps may be substantially circular
or formed from slots (FIG. 2) or a space between protrusions, for
instance.

[0037] In an axial direction, the tip part 4 is located farther out than
the finger part 3, 6, and the tip part comprises a suction inlet 10 (FIG.
4a) communicating with a channel, The tip part is arranged to be rotated
around the axial direction of the frame, and the tip part may thus be
arranged to be moved into several different positions located at a
predetermined angle from one another.

[0038] FIGS. 1 and 2 show the annular part 3 to be fixedly fastened to the
frame 2. According to another preferred embodiment, the finger part, like
the annular part, may be detachably or movably fastened to the frame. The
mutual position of the ring 3 and the frame 2 may be adjustable, i.e. the
finger part 3 may be movable in the longitudinal, axial or vertical
direction of the frame 2. In addition to or instead of this, the tip part
4 may be adjustable or movable in the axial direction with respect to the
finger part 3.

[0039] The movability may be achieved in many different ways. At its
simplest, the ring 3 may consist of two parts, resembling a figure eight,
whereby the frame 2 passes through the smaller ring part while the finger
part 3 slides along the frame by means of a small force. This enables
individual and appropriate working ergonomics to be easily adjusted for a
worker. At the same time this enables the worker to work accurately. In
both cases, the finger part may be fastened to the frame at one or more
fastening points.

[0040] As mentioned above, the tip part 4 may be a separate part which is
fastened to the free end of the frame 2, to the end opposite the end of
the suction machine. However, at its simplest, no such separate tip part
exists but the free end of the frame as such serves as a tip part. The
free end of the frame 2 may be both shaped appropriately and provided
with incisions or the like as well. If necessary, when using a separate
tip part 4, it may be adjustable in the longitudinal direction with
respect to the frame 2. A simple longitudinal adjustment is achieved by
means of threads. The part 4 is screwed to an outer end of the frame 2,
into a desired depth so as to achieve accuracy and good usability. The
tip part 4 is also made from plastic in particular.

[0041] The purpose of the instrument is also to enable working alone, and
according to the invention and its preferred embodiments it is thus
possible to easily direct suction accurately by means of one finger to a
target area and within the target area while at the same time the rest of
the fingers of the hand directing the instrument and also partly the
finger using the instrument are fully operational e.g. for lifting a
patient's lip or being used for other procedures in the field. The
instrument may be particularly disposable, to be disposed of after being
used for a given patient. The manufacturing materials of the instrument
make it highly suitable for energy waste.

[0042] FIGS. 4a, 4b, and 4c show a tip part and a finger part according to
the invention and its preferred embodiments. In FIG. 4a, the finger part
and the tip part are shown from below, in FIG. 4b the finger part and the
tip part are shown from above, and FIG. 4c is a side view of the finger
part and the tip part.

[0043] The finger part may be annular, as shown in FIG. 1, or sheath-like,
as shown in FIGS. 4a to 4c. The sheath-like finger part 6 may be arranged
on a tip member 41 (FIG. 6) and/or on a middle member 42 (FIG. 6) of a
finger 40 (FIG. 5). The finger part may extend all the way to a base
member 43 (FIG. 6). The finger is pushed into the sheath-like finger part
so that the sheath covers one or more parts of the finger. The sheath may
cover e.g. the tip part of the finger and the middle member of the
finger, and the opening in the sheath at, above and/or below a distal
interphalangeal joint 44 (FIG. 6) leaves the distal interphalangeal joint
free. When the joints of the finger, e.g. the distal interphalangeal
joint and a proximal interphalangeal joint 45 (FIG. 6) remain free, e.g.
when using a finger part fastened to the middle member, no stress or
compressive force is imposed on the joints. This prevents the distal
interphalangeal joint and the proximal interphalangeal joint from being
subjected to stress when the finger is moved in order to direct the tip
part. Since the finger part is not attached to a metacarpophalangeal
joint 46 (FIG. 6) of the finger, the end of the frame is not left
hanging, which would make the suction substantially less directable to
the target area.

[0044] The sheath part may also be fastened to the frame at one or more
fastening points 22 (FIG. 4c) which may be provided at the rear and front
ends of the sheath part, for instance. A fastening point may also be
arranged to surround the frame entirely. The sheath-like finger part may
be provided with one or more openings 20, 21 for leaving one or more
joints free. In addition to ergonomics, this improves the directability
of the instrument and the ventilation of the tip part. The openings may
be provided in an upper surface 20 and/or lower surface 21 of the sheath
part, for instance.

[0045] An end of the frame may thus be provided with a tip part 4. The tip
part is located after the finger part in the axial direction. The tip
part may be arranged either fixedly or detachably.

[0046] The tip part may be arranged in the frame in many different ways.
The tip part may be fastened directly to the frame or the frame may be
provided with an adjusting part or a connecting part to which the tip
part or a forepart of the tip part is fastened. The tip part may also be
fixedly or movably arranged in the frame. FIGS. 7a, 7b, and 7c show an
arrangement of a tip part in the frame according to a preferred
embodiment of the invention, wherein the tip part is arranged to be
rotated around the axial direction of the frame.

[0047] FIG. 7a is a sectional view. Therein, the frame 2 is provided with
a connecting part 60 in which the tip part 4 may be arranged. The figure
also shows a locking protrusion 50 which is arranged in an inner surface
of the tip part and which may be arranged in a receiving groove provided
in the connecting part. FIG. 7a also shows other protrusions 17 and
openings 16.

[0048] FIG. 7a describes a situation wherein a locking protrusion is
provided on a rotary groove while FIG. 7b is a sectional view of a
situation wherein the locking protrusion 50 is in a locking position of a
rotational motion.

[0049] In FIG. 7c, the locking protrusion attached to the inner surface of
the tip part is provided on a rotary groove while in FIG. 7d the locking
protrusion is in a locked position of the rotational motion. As can be
seen in FIG. 7c, a locking recess or a receiving groove is arranged to
receive the locking protrusion or locking projection. According to an
alternative embodiment, the connecting part comprises a locking recess
while the tip part comprises a locking groove.

[0050] A locking ring 53 (FIG. 7d) to be used in the locking may be shaped
in many different ways. It may comprise one or more guide surfaces 52 for
guiding a locking protrusion and a locking recess for receiving a locking
protrusion. According to a preferred embodiment, the number of locking
recesses is three or four. The tip part may thus be moved into several
different positions located at a predetermined angle from one another. If
the angles are equal in magnitude, as a function of the numbers of said
locking recesses, the moving takes place at angles of about 120 degrees
or about 90 degrees, The angles of rotation may also differ in magnitude,
in which case the tip part may be moved e.g. such that the tip part may
first be moved by about 30 degrees, then by about 15 degrees and further
by about 30 degrees. The locking positions of the locking protrusion may
thus be provided at distances of the same or different angle magnitude.

[0051] FIGS. 8a, 8b, and 8c show an adjustment and rotation mechanism for
a tip part according to the invention and its preferred embodiments both
in a side sectional elevation and as seen from above. The frame 2 may be
provided with an adjustment part, a connecting part or a locking ring 53.
The locking ring comprises four locking recesses 51 and a mounting groove
54. The mounting groove enables the tip part to be arranged in or
fastened to the connecting part, in which case a projection or protrusion
in the tip part may be brought to a rotary groove by means of the
mounting groove. Reference number 55 designates a rotary groove for a
protrusion provided in the tip.

[0052] The tip part is moved by pulling the tip outwards or by pushing it
inwards and rotating in order to achieve a desired position. The tip
locks at intervals of about 90 degrees, for instance, and it may be
released simply by pushing the tip slightly inwards, which makes the
locking protrusion return to the rotary groove. At this stage, the tip
may be turned into a desired position. The locking takes place by pulling
the tip slightly outwards, which makes the locking protrusion slide into
a locking position. The wide forepart of the locking recess guides the
locking protrusion into a correct angle, making the angle of the tip part
easier to adjust. When the tip part is rotated in the axial direction
between locking positions, the frame is allowed to remain immobile.

[0053] FIG. 8c is a side sectional elevation of a mounting groove for a
tip. if the mounting groove is inclined, once the tip is fastened in
place it can no longer be removed. In such a case, the inclination
prevents the tip from becoming detached from the connecting part and
keeps it in place in the connecting part.

[0054] The tip part may consist of one or more parts e.g. such that a
first part is a fastening part to be fixedly mounted to the frame while a
second part is an extension part to be mounted to the fastening part.
According to a preferred embodiment, the tip part may be adjusted in the
longitudinal direction so as to enable work to be carried out accurately
in back areas of the mouth. The extension may be about 2 to 5 mm, for
instance, and this extension may be achieved by threads or a slide
mechanism, for instance.

[0055] The entire tip part or the extension part of the tip part may be
rotatable. The rotating angle may be e.g. about 90 degrees, about 180
degrees or about 360 degrees. The rotation enables the tip to be always
directed accurately to the working area at all working stages where
materials or liquids have to be removed from the patient's mouth or where
a point in the patient's mouth has to be scraped or polished.
Consequently, neither the awkward and ergonomically harmful tweezer grip
nor any twisting of the wrist in combination therewith is necessary for
directing the tip. In addition, harmful uplifting motions of the upper
limbs become eliminated completely. When the removal of liquids and other
substances and materials is more accurate, the visibility of the working
area is also improved, which contributes to the worker's ability to
maintain the ergonomically correct working and sitting posture during
work.

[0056] According to a preferred embodiment, the separate tip part provided
at the end of the frame rotates by about 360 degrees, enabling suction to
be directed accurately at its target, such as teeth, in which case the
work, such as removal of liquid from the working area, is more accurate
and the visibility is better with the suction tip or high volume
evacuation tip according to the invention than when using a conventional
high volume evacuation tip. This results in a further advantage that the
worker is able to maintain the ergonomically correct working and sitting
posture during work. While the tip part may be rotated by 360 degrees,
rotating it by 180 degrees helps when working with the suction tip at the
front teeth.

[0057] According to a preferred embodiment, the tip locks at intervals of
about 90 degrees, four different substantially equally spaced positions
being sufficient for directability. In other words, the tip part may
rotate about 360 degrees e.g. such that it may be moved by about 90
degrees at a time. After being moved by 90 degrees, the tip part may be
locked at this angle or position by means of grooves and threads provided
in the tip connecting part and the frame connecting part, for instance.
From this position it may be rotated by another 90 degrees in the same
direction, in which case the tip part has turned by 180 degrees. The same
motion may be continued such that next the tip part has turned by 270
degrees and then returns again to its original angle after having turned
by a total of 360 degrees. However, it is to be noted that the rotating
angle and the overall rotating angle may also be an angle other than any
of those mentioned above and that the rotating angle may also be
different at different stages.

[0058] The tip part may thus be arranged to rotate restrictedly or freely.
Rotation may also be prevented by various mechanisms, such as block
stops. The rotational motion of the tip part may be prevented or
restricted e.g. such that the tip part is lockable by one or more
friction fits or as arranged at a given motion angle.

[0059] The difference in distance between the grooves and threads provided
in the tip connecting part and the frame connecting part also makes it
possible to adjust the length of the tip part, so the tip part may,
enabled by the threads, slide an axial distance allowed by the threads.

[0060] The tip part or nozzle 4 may be shaped so as to make the work even
more accurate. A distal end of the tip part may be rounded, as shown in
FIG. 4b. As seen from the side, the tip part may be bevelled, as shown in
FIG. 4c. An angle α between a substantially planar surface 19
defined by the suction inlet and the axial direction is normally greater
than about 25 degrees. The angle may preferably be about 30, 35, 45 or 50
degrees.

[0061] The tip part may be provided with one or more axial openings and/or
radial openings. The distance between the radial openings and an end of
the suction inlet may be anything from a couple of millimetres to a
couple of centimetres.

[0062] The tip part may also be provided with one or more protrusions,
projections or protuberances. Protrusions 12 may be provided e.g. on a
circumference 11 defining the suction inlet 10, in a first surface of the
tip part, e.g. in an upper surface 18, in a second surface of the tip
part, e.g. in a lower surface 17, or on sides of the tip part. The
protrusions or projections or, in addition or alternatively to these, one
or more grooves or slots provided in the tip part, such as an air opening
16 arranged in the upper surface of the tip part shown in FIG. 4c,
prevent the tip from adhering to the target surface in a use situation
e.g. owing to an air flow as well as let the flow pass from below them.
These prevent underpressure formation so that the suction tip does not
become attached to tissue or mucosa. Reference number 13 designates an
air opening provided in an upper part of the tip part as seen from below.

[0063] The protrusions of the tip part may further be used as so-called
scrapers in procedures, e.g. when a whitening agent is to be scraped and
simultaneously aspirated from a surface of a tooth in connection with
teeth whitening.

[0064] The fastening of the tip part and the finger part may be a fixed
one or a detachable one. The fastening may be carried out e.g. by gluing,
heating, melting, mechanical fastening or integration. If the product is
manufactured from pressed plastic, the fastening of the finger part may
be fixed, i.e. the finger part or sheath part as well as in addition or
alternatively to the tip part may be an integrated part of the product.

[0065] As described in FIG. 4a, the tip part is provided with a large
suction inlet, an opening 10, in which case its suction power is greater,
which makes it more efficient in removing liquids and better in
maintaining visibility.

[0066] FIG. 5 shows a finger part, a sheath part 6 according to the
invention and its preferred embodiments. The sheath part has two openings
20, 21 in order for the distal interphalangeal joint not to be subjected
to compression, pressure or stress as well as in order to enable accurate
working and ventilation. The sheath part may further include a special
area containing a material for producing a good adhesiveness to a finger.
This so-called grip area may be located in a tip part 30 of the sheath,
in the inner surface of the sheath or as a separate layer inside the
sheath. A similar adhesive structure may also be used in the annular
finger part.

[0067] Both the tip part and the finger part may be manufactured from a
soft and elastic material, such as plastic. In such a case, the rotatable
suction tip to be attached to a finger is also tissue-friendly and
comfortable to the patient. The frame, as the rest of the structure in
its entirety as well, may also be made from a biodegradable silicon or
another plastic material.

[0068] By way of example, the inner diameter of the frame may be about 3
to 7 mm, but it may also be considerably larger than this value.

[0069] The finger part, as the finger ring or finger sheath, may be
arranged on the middle member of the finger as well as in the frame of
the instrument. The finger part attached to the middle member leaves the
distal interphalangeal joint free. In such a case, no pressure or
compressing force is imposed on the distal interphalangeal joint. This
makes it possible to prevent the distal interphalangeal joint from being
subjected to stress when the finger is moved in order to direct the
suction tip. The above-described finger attachment particularly enables
the suction to be directed accurately to a working area.

[0070] FIG. 9 shows an instrument according to the invention and its
preferred embodiments with the tip part detached. In the figure, the
instrument 1 consists of a frame part 2 and a tip part 4 to be detachably
connected thereto. In a use situation, the tip part resides inside a tip
of the frame part. The frame part may also be detachably provided with a
tube part (not shown in the figure). One or more channels for an air flow
may be arranged inside the instrument. A channel is formed by a passage
running from the tip part via the frame part to the tube part.

[0071] The finger part 3 of the instrument may be fastened directly to the
frame part by a curved support 22, or the finger part may be attached to
an adjusting part 23 which may be fastened to the frame part. The finger
part may also be integrated in the frame part, in which case the frame
part is one part comprising the finger part. As can be seen in FIG. 9,
the axial direction of the tip of the finger part 3 is substantially
parallel with the axial direction of the tip part 4. In such a case, the
direction of a finger tip is substantially towards a work target. As can
be seen in FIG. 9, the finger part is in the axial direction located
farther on than the tip part.

[0072] The finger part may be provided with one or more cuts 20 dividing
the finger part 3 into two parts, a front part 3a and a rear part 3b. The
cut provides the finger part with elasticity, among other things. The
elasticity shows e.g. such that when the frame part bends the finger part
bends. The finger part and the frame part at the finger part are arranged
substantially on the same radius as a finger in a rest position, because
the fingers of a hand in a rest position are slightly bent. In such a
case, the finger is subjected to the least stress, and the position of
the finger is as natural as possible. The cut made in the finger part
enables the distal interphalangeal joint to be left free, so the finger
can be bent without it being subjected to pressure or stress by the
finger part.

[0073] The frame part and the finger part of the frame part may thus be
curved in their rest position or they may curve in a use situation. If
the frame part and the finger part of the frame part are curved in their
rest position, the cut in the finger part, among other things, makes it
possible to bend them even further.

[0074] When a finger sheath is used as the finger part and a radius is
used for the frame part and the finger sheath where the finger in the
sheath is substantially in the rest position, the finger and the hand as
well as the wrist are subjected to the least stress. In such a case, a
downwards pulling weight caused by the suction tubing of a treatment
machine does not impose any stress on the finger, either. This also plays
a part in enabling the instrument to be directed accurately even while
working for long periods of time. In other words, the usability and
directability of the instrument improve and the weight is divided
optimally and evenly on the finger, the finger tip and the middle part of
the finger. It is further to be noted that the rest position of the
finger influences the position of the wrist, the muscles of the wrist and
the tendons of the wrist, which, in turn, has a bearing on the position
of the entire hand, elbow and upper arm, the muscles and the tendons.

[0075] In addition, the one or more cuts provided in the finger part make
the finger part lighter since because of the cut it contains less
material. In order to enhance the accurate directability of the suction
tip as well as the even distribution on the finger and the hand of the
weight imposed by the suction tubing of the treatment machine on the hand
and the finger, the ergonomic finger part may thus be arranged to consist
of two parts. According to FIG. 9, the front part of the finger sheath is
arranged on the tip member of the finger while the rear part of the
finger sheath is arranged on the middle member of the finger.

[0076] An end to be fastened to a tube part of the frame part or to a
suction tube may have a shape resembling that of a Christmas tree similar
to that shown in FIGS. 9, 10, and 11. The protrusions 90 of the Christmas
tree are received into the suction tube, they are arranged to penetrate
into the suction tube and prevent the suction tube from becoming detached
from the frame part during use of the instrument. A tight fastening is
achieved more easily if the frame part and the suction tube are made of
materials having different hardnesses. The frame part may be made from a
harder material than the tube part, in which case the tube part yields
when the frame part is inserted therein. The diameter at a protrusion may
be dimensioned to be slightly larger than the inner diameter of the
suction tube, which results in a very tight connection.

[0077] A tip of the frame part may be provided with members for
longitudinal adjustment of the tip part. The members may be e.g. grooves,
recesses or projections. These may be transverse. The number of
projections may be e.g. three 70, 71, 72 in the surface of the frame part
in a direction perpendicular to the axial direction of the frame part,
and they are meant for the longitudinal adjustment of the tip part. The
projections may be located at intervals of 5 mm, for instance. The last
projection 70 of the three projections residing at the end of the tip of
the frame part is wider and higher. Its purpose is to prevent the
separate tip part or suction tip from becoming detached. In the described
manner, for instance, the tip part is adjustable in the axial direction
by means of friction adjustment.

[0078] The measurements of the tip part and its distance from the frame
part are arranged such that the use of the tip part in different
procedures is accurate, efficient and reachable. Reachability means that
it is capable of reaching all treatment areas that are to be reached. The
adjustability of the length of the tip part enables easy, efficient and
accurate working in different treatment areas, such as the oral cavity.
Then, when working on back teeth, for instance, a position is used which
reaches farther, and when working on front teeth a less far reaching
position is used. The tip part may be arranged such that the total length
of movement in the axial direction is e.g. about 10 mm, about 15 mm or
about 19 mm. The distance of the tip of the tip part from the end of the
tip of the finger part may be e.g. about 20 mm, about 26 mm or about 31
mm. The length of the tip part with respect to the frame part in the
axial direction of the frame part may be about half or one third, for
instance. The length of the tip with respect to the finger part in the
axial direction of the frame part may be about half or two thirds, for
instance.

[0079] The tip of the frame part may also comprise longitudinal
projections and grooves 73. They are provided for achieving and adjusting
the rotation of the tip part e.g. gradually. The inner surface of the tip
part has a shape corresponding to that of the projections and grooves of
the tip of the frame part, enabling the tip part to be rotated.
Consequently, the rotating motion of the tip part may emit a snap.

[0080] As described above, the tip part may be rotated in the axial
direction and/or in the rotation direction.

[0081] One or more protrusions 17 of the tip part 4 on a suction surface
and one or more air openings 16 on the sides of the tip prevent the tip
part provided with a suction inlet 10 from becoming underpressurized,
thus preventing it from adhering to the mucosa. The protrusions may also
be used for scraping the target area.

[0082] An adhesive surface or projections 80 may be arranged on the outer
surface of the tip part in order to enhance adhesiveness to the tip part.
The shape of the tip may be made to widen forwardly, which results in a
more efficient suction surface and a more robust tip. This is
advantageous in that the tip may easily be used for moving e.g. a lip or
a cheek out of the working area or out of the way of the working area.

[0083] FIG. 10 shows a finger part of an instrument according to an
embodiment of the invention as seen from behind. The sheath-like finger
part 3 is provided with one cut 20. The figure also shows a fitting 90 to
a suction tube.

[0084] FIG. 11 is a front view showing a finger part of an instrument
according to an embodiment of the invention. The sheath-like finger part
3 enables a suction inlet 10 provided in the tip part to be directed
accurately and efficiently to a target area. A circumference 11 defining
the suction inlet may be provided e.g. with four, seven or eight
protrusions 17 in order to enhance working in the target area.

[0085] An advantage of the invention and its preferred embodiments is that
the instrument may be directed accurately and efficiently to the working
area. A further advantage is that at the same time stresses imposed on a
worker may be minimized. Particularly the working accuracy and work
ergonomics of an oral care professional working alone at a practice may
be improved simultaneously.

[0086] By using the instrument according to the invention and its
preferred embodiments, the operator becomes "three-handed", and in
addition to suction, he or she is able to use lighting or e.g. a mouth
mirror or another instrument by means of the instrument hand.

[0087] The invention can replace the use of a conventional high volume
evacuation tip completely. When the frame according to the invention and
its preferred embodiment provided with a suction tip or high volume
evacuation tip settles via the finger part on the middle member or on the
middle member and the tip member of the finger, the end of the frame is
not left hanging, which enables it to be directed accurately to a desired
target area. In such a case, no compression force which imposes stress on
the fingers nor said compression force combined with bending or twisting
motion of the wrist is necessary for removing liquids and directing the
suction tip to the working area. This enables the most natural, less
stressful, and ergonomically appropriate working motions for the hand,
the wrist and the neck-shoulder area particularly when working alone, as
compared with the commonly known suction tip procedures and, for
instance, a risk of developing a medical condition called a Canalis carpi
syndrome is reduced considerably.

[0088] Because the work postures are static when using the high volume
evacuation tip, it may happen that the same uncomfortable posture has be
to kept even for long periods of time. In conventional working, the use
of the high volume evacuation tip is inaccurate as well as inconvenient
and ergonomically stressful not only for the joints of the fingers but
also for the wrist and the neck-shoulder area. When the movement of the
thumb is difficult, the long abductor tendon and the short extensor
tendon of the thumb become irritated in their tendon sheath. The signs of
inflammation on a side of the wrist facing the thumb include local pain
and swelling. This is a very common condition among oral hygienists, and
the condition is called a suction hand syndrome. The continuous
repetitive motion as well as sidewise and twisting motions of the wrist,
which are risk factors for de Quervain's tenosynovitis, can now be
avoided or minimized. The use of the conventional high volume evacuation
tip is inconvenient not only to the worker but also to the patient, and
since the high volume evacuation tip is a sharp-edged plastic tube, it
often inflicts wounds on the patient's lips or mucosa during treatment.
These drawbacks can now be eliminated.

[0089] In addition to the removal of liquids and other substances and
material, examples of special procedures that now become more accurate
and efficient include e.g. ultrasonic tartar removal, tartar removal with
manual instruments, application of topical anesthesia, and removal of
discolorations by using a powder cleaner. These will be described in the
following.

[0090] In the profession of an oral hygienist, the use of ultrasonic
devices for the removal of tartar has increased as the devices have
become more sophisticated. The ultrasonic devices make tartar removal
faster and more cost-efficient as compared with the manual instruments.
The operation of ultrasonic devices is based on ultrasonic vibration in
water, which is why during their use a patient's mouth receives a lot of
water and the visibility of the working area is poor. A tip part to be
attached to a finger and rotating e.g. about 360 degrees enables the
suction tip to be directed accurately to the working area, which makes
liquid removal more efficient, improves visibility and makes an
ergonomically correct work posture easier to maintain. The large suction
inlet of the tip part prevents an aerosol cloud containing bacteria and
microbes and generated during the use of the ultrasound device from
spreading on the premises, enabling a harmful microbial load on the
patients and workers to be reduced and thus occupational safety to be
also influenced.

[0091] The suction tip to be attached to a finger makes it possible to
avoid reaching out for and fetching a suction tip in procedures involving
bloodshed, e.g. in connection with manual removal of tartar when inflamed
gums bleed heavily. The finger part to be arranged in the frame and the
rotatable tip part make it possible to maintain visibility accurately
during the entire cleaning procedure, enabling an ergonomically correct
work posture to be maintained. Stress imposed on the shoulders and upper
arms is also reduced since no need exists to reach out for the suction
tip from its holder.

[0092] In dental care procedures, liquid local anesthetic agents are used
that are dispensed by a dispensing tip into gingival pockets. When
applying a liquid local anesthetic agent, it is important to prevent the
local anesthetic agent from spreading into saliva and therewith into the
patient's throat. A local anesthetic agent flowing into the patient's
throat numbs pharyngeal mucosa and is extremely unpleasant and
frightening to the patient. The instrument arrangeable on a finger and
comprising a rotatable tip part may be directed accurately to the working
area, following the teeth, which enables any excess local anesthetic
agent to be prevented from spreading into saliva and therewith into the
patient's throat. Consequently, a more accurate removal of a harmful
substance from the patient's mouth, a safer and more convenient treatment
to the patient as well as a considerably more accurate and ergonomically
better way for the worker to remove any excess anesthetic agent are
achieved, as compared with the use of a prior art high volume evacuation
tip.

[0093] Discolorations of teeth are removed using powder cleaners. The
powder used in powder cleaners irritates the patient's mucosa, and it is
important to try to prevent a powder jet from hitting against the mucosa
during the cleaning procedure. The tip part to be attached to a finger
and having a high suction power and being rotatable by e.g. about 360
degrees enables the instrument to be directed accurately to the working
area, preventing the powder jet which causes mucosal stinging and wounds
from directly hitting against the mucosa of the tongue, lip, cheek or the
palate. The procedure may be carried out ergonomically for the worker and
safely for the patient. By using the prior art high volume evacuation
tip, said procedure is very difficult to carry out since when working
alone, the high volume evacuation tip is difficult to direct accurately
to the working area.

[0094] According to the invention and its preferred embodiments, filling
procedures may also be made more accurate. In the filling procedures,
plastics have almost replaced metals as tooth filling materials. The
increased use of plastics has resulted in an increasing number of
work-related allergies generated in dental care. Methacrylate-containing
plastic materials are used e.g. for teeth filling and making dentures.
Methacrylates are highly allergenic and may cause skin, eye and
respiratory tract irritation symptoms.

[0095] Allergic contact eczema has been caused mainly by tooth filling
pre-treatment, sealant, filling and coating agents. Of the pre-treatment
agents, primers usually contain 2-hydroxyethylmethacrylate (2-HEMA).
Photocurable sealant, filling and coating materials usually contain at
least triethylene glycol dimethacrylate and often epoxy dimethacrylate
(e.g. bis-GMA) or urethane dimethacrylate. Many acrylic compounds may
also cause work-related rhinitis, asthma, laryngitis and pharyngitis as
well as conjunctivitis.

[0096] The invention enables a better visibility of the working area to be
ensured. In the preparation of a tooth, dental drills are used whose
cooling water has to be removed from the patient's mouth. By directing
accurately the suction tip to the working area, the cooling water can be
removed efficiently and thus a better visibility of the working area can
be ensured, making it easier to maintain an ergonomically correct work
posture. The improved visibility of the working area also enables a
better work quality to be achieved.

[0097] In filling procedures, when the prepared tooth is prepared for
being filled with a filling material, it is important that the tooth to
be filled remains completely dry, since otherwise the fastening of a
plastic filling to the tooth cannot be guaranteed. By directing the
suction tip accurately to the filling area by means of the invention, it
can be ensured that the filling area is completely dry and a high-quality
filling and related procedure are achieved.

[0098] When teeth are filled with plastic, dentin and enamel are treated
with different pre-treatment, sealant, filling and coating agents. These
chemical agents are extremely allergenic and detrimental both to the
workers and the patients. These chemical agents have to be dispensed onto
the teeth and washed off the teeth. It is then important to keep the
suction tip very close to the tooth to enable any excess chemical agents
that are escaping from the surface of the tooth to be aspirated from the
working area. In addition, air is blown onto the pre-treatment and
sealant agents used in plastic filling in order to dry them and make them
spread evenly over the tooth. The aerosol generated in said procedure is
extremely detrimental and allergenic. The invention enables the suction
tip to be directed more accurately to the working area, which makes it
possible to reduce the spreading of the detrimental aerosol into the
breathing air and thus the occupational safety of the workers to be
improved.

[0099] In the finishing and polishing procedures, in addition to the
cooling water, amalgams and plastic filling residues are formed in the
patient's mouth that have to be removed therefrom. The invention enables
the suction tip to be brought accurately to the finishing area, which
makes it possible to remove said materials from the patient's mouth in a
better and more careful manner. The invention also enables the cooling
water to be removed efficiently and thus a better visibility of the
working area, better working ergonomics and a higher work quality to be
ensured.

[0100] It is to be noted that even if the instrument has been described
above in connection with oral and dental care, the instrument may also be
used in other medical procedures, such as paramedical treatment,
anesthetic treatment or intensive care, for aspirating the patient's
respiratory tract, for instance. Ordinarily, suction of the respiratory
tract refers to drawing off saliva and other secretions by suction from
the patient's mouth, nose or throat. The most common places subjected to
suction are the mouth, the nose, the throat, and the lower respiratory
tract. Sometimes it is also necessary to suck vomit or blood if the
patient him- or herself cannot cough or spit, e.g. when the patient is
unconscious. The purpose of aspiration is to ensure exchange of gases
when a large amount of secretion is present in the respiratory tract or
the patient has aspirated and is incapable of cleaning his or her
respiratory tract by coughing. Secretions in the mouth and throat, such
as mucus, vomit and blood, prevent normal breathing. A health care
professional observes the patient's mucus secretion from the respiratory
tract and decides when it is necessary to use suction. It is usually
necessary to aspirate the respiratory tract of a patient after intubation
or tracheostomy. For aspirating the throat and mouth, the instrument may
be used arranged in an electrically or pneumatically operated suction
device, for instance. The instrument according to the invention and its
preferred embodiments may also be used in different procedures and
surgical operations, such as in surgical operations and visceral surgery
requiring surgical suction devices, in procedures of both human and
veterinary medicine, as well as in cosmetic treatment procedures and
operations.